The term "electrotransport" as used herein refers generally to the delivery of an agent (eg, a drug) through a membrane, such as skin, mucous membrane, or nails, which delivery is induced or aided by the application of an electric potential. For example, a beneficial therapeutic agent may be introduced into the systemic circulation of an animal (eg, a human) by electrotransport delivery through the skin.
The electrotransport process has been found to be useful in the transdermal administration of drugs including lidocaine hydrochloride, hydrocortisone, fluoride, penicillin, dexamethasone sodium phosphate, and many other drugs. Perhaps the most common use of electrotransport is in diagnosing cystic fibrosis by delivering pilocarpine salts iontophoretically. The pilocarpine stimulates sweat production; the sweat is collected and analyzed for its chloride content to detect the presence of the disease.
Presently known electrotransport devices use at least two electrodes, positioned in intimate contact with some portion of the body (eg, the skin). A first electrode, called the active or donor electrode, delivers the therapeutic agent (eg, a drug or a prodrug) into the body by electrotransport. The second electrode, called the counter or return electrode, closes an electrical circuit with the first electrode through the patient's body. A source of electrical energy, such as a battery, supplies electric current to the body through the electrodes. For example, if the therapeutic agent to be delivered into the body is positively charged (ie, a cation), the anode will be the active electrode and the cathode will serve as the counter electrode to complete the circuit. If the therapeutic agent to be delivered is negatively charged (ie, an anion), the cathode will be the donor electrode and the anode will be the counter electrode.
Alternatively, both the anode and cathode may be used to deliver drugs of opposite electrical charge into the body. In this situation, both electrodes are considered donor and counter electrodes. For example, the anode can simultaneously deliver a cationic therapeutic agent and act as a "counter" electrode to the cathode. Similarly, the cathode can simultaneously deliver an anionic therapeutic agent into the body and act as a "counter" electrode to the anode.
A widely used electrotransport process, electromigration (also called iontophoresis), involves the electrically induced transport of charged ions. Another type of electrotransport, electroosmosis, involves the flow of a liquid solvent from the donor reservoir, which liquid contains the agent to be delivered, under the influence of the applied electric field. Still another type of electrotransport process, electroporation, involves the formation of transiently existing pores in a biological membrane by the application of high voltage pulses. A therapeutic agent can in part be delivered through the skin by passive diffusion by reason of the concentration difference between the concentration of drug in the donor reservoir of the electrotransport device and the concentration of drug in the tissues of the patient's body. In any given electrotransport process, more than one of these processes may be occurring simultaneously to a certain extent. Accordingly, the term "electrotransport", as used herein, should be given its broadest possible interpretation so that it includes the electrically induced or enhanced transport of at least one therapeutic agent, whether charged, uncharged, or a mixture thereof.
The terms "drug" and "therapeutic agent" are used interchangeably and are intended to have their broadest interpretation, namely any therapeutically active substance that is delivered to a living organism to produce a desired, usually beneficial, effect. This includes therapeutic agents in all the major therapeutic areas including, but not limited to: anti-infectives such as antibiotics and antiviral agents; analgesics, including fentanyl, sufentanil, buprenorphine and analgesic combinations; anesthetics; anorexics; antiarthritics; antiasthmatic agents such as terbutaline; anticonvulsants; antidepressants; antidiabetic agents; antidiarrheals; antihistamines; anti-inflammatory agents; antimigraine preparations; antimotion sickness preparations such as scopolamine and ondansetron; antinauseants; antineoplastics; antiparkinsonism drugs; antipruritics; antipsychotics; antipyretics; antispasmodics, including gastrointestinal and urinary; anticholinergics; sympathomimetrics; xanthine derivatives; cardiovascular preparations, including calcium channel blockers such as nifedipine; beta blockers; beta-agonists such as dobutamine and ritodrine; antiarrythmics; antihypertensives such as atenolol; ACE inhibitors such as ranitidine; diuretics; vasodilators, including general, coronary, peripheral, and cerebral; central nervous system stimulants; cough and cold preparations; decongestants; diagnostics; hormones such as parathyroid hormone; hypnotics; immunosuppressants; muscle relaxants; parasympatholytics; parasympathomimetrics; prostaglandins; proteins; peptides; psychostimulants; sedatives; and tranquilizers.
Electrotransport is also useful in the controlled delivery of peptides, polypeptides, proteins and other macromolecules. These macromolecular substances typically have a molecular weight of at least 300 Daltons, and more typically have a molecular weight of 300-40,000 Daltons. Specific examples of peptides and proteins in this size range include, without limitation, the following: LHRH; LHRH analogs such as buserelin, gonadorelin, nafarelin and leuprolide: insulin; insulotropin; calcitonin; octreotide; endorphin; TRH; NT-36 (chemical name is N=[[(s)4-oxo-2-azetidinyl] carbonyl]-L-histidyl-L-prolinamide); liprecin; pituitary hormones such as HGH, HMG and desmopressin acetate; follicle luteoids; aANF; growth factors such as growth factor releasing factor (GFRF or GHRH); bMSH; somatostatin; bradykinin; somatotropin; platelet-derived growth factor; asparaginase; chymopapain; cholecystokinin; chorionic gonadotropin; corticotropin (ACTH); erythropoietin; epoprostenol (platelet aggregation inhibitor); glucagon; HCG; hirulog; hyaluronidase; interferon; interleukins; menotropins (urofollitropin (FSH) and LH); oxytocin; streptokinase; tissue plasminogen activator: vasopressin; desmopressin; ACTH analogs; ANP; ANP clearance inhibitors; angiotensin II antagonists: antidiuretic hormone agonists; antidiuretic hormone antagonists: bradykinin antagonists: CD-4; ceredase; CSFs; enkephalins; FAB fragments; IgE peptide suppressors; IGF-1; neurotrophic factors; colony stimulating factors: parathyroid hormone and agonists; parathyroid hormone antagonists: prostaglandin antagonists; pentigetide; protein C; protein S; renin inhibitors; thymosin alpha-1; thrombolytics; TNF; vaccines; vasopressin antagonist analogs; alpha-1 antitrypsin (recombinant); and TGF-beta.
Electrotransport devices generally require a reservoir or source of the agent, or a precursor of such agent, that is to be delivered into the body by electrotransport. Examples of such reservoirs or sources of, preferably ionized or ionizable, agents include a pouch as described in Jacobsen U.S. Pat. No. 4,250,878, or a pre-formed gel body as disclosed in Webster U.S. Pat. No. 4,383,529. Such reservoirs are electrically connected to the anode or the cathode of an electrotransport device to provide a fixed or renewable source of one or more desired therapeutic species.
Recently, a number of U.S. patents have issued in the electrotransport field, indicating a continuing interest in this mode of drug delivery. For example, Vernon et al U.S. Pat. No. 3,991,755, Jacobsen et al U.S. Pat. No. 4,141,359, Wilson U.S. Pat. No. 4,398,545, and Jacobsen U.S. Pat. No. 4,250,878 disclose examples of electrotransport devices and some applications thereof.
More recently, electrotransport delivery devices have become much smaller, particularly with the development of miniaturized electrical circuits (eg, integrated circuits) and more powerful light weight batteries (eg, lithium batteries). The advent of inexpensive miniaturized electronic circuitry and compact, high-energy batteries has meant that the entire device can be made small enough to be unobtrusively worn on the skin of the patient, under clothing. This allows the patient to remain fully ambulatory and able to perform all normal activities, even during periods when the electrotransport device is actively delivering drug.
Nevertheless, some limitations still remain, restricting the wider application of this valuable technique. One such limitation is the size and cost of electrotransport delivery devices. In particular, the batteries needed to power electrotransport devices comprise a significant contribution to the overall size and weight, as well as the cost, of these smaller, patient-worn electrotransport delivery devices. A reduction in the number and/or cost of these batteries would allow electrotransport drug delivery devices to be made smaller and at lower cost.
One method of reducing the number of batteries used to power an electrotransport device is to use a voltage boosting circuit. Boosting circuits are well known in the electrical arts. Conventional boosting circuits take an input voltage (eg, 3.0 volts) and boost it by a predetermined multiple (eg, .times.2) to give a "boosted" output voltage (eg, 6.0 v=3.0 v.times.2). Voltage boosting circuits have been used in transdermal electrotransport delivery devices. See Maurer et al U.S. Pat. No. 5,254,081 (at column 2, lines 34-39).
These circuits allow an electrotransport device to deliver a predetermined level of electric current with fewer batteries, or battery(ies) of lower voltage, than would otherwise be needed without the use of a boosting circuit. Thus, conventional boosting circuits help reduce the size and cost of an electrotransport delivery device by requiring fewer, and/or lower voltage, batteries to power the device.
The problem of reducing the cost of the power supply for an electrotransport delivery device is complicated by the fact that the electrical resistance of the patient body surface (eg, skin) is not constant during electrotransport delivery. Since the voltage (V) necessary to drive a particular level of electric current (i) through the patient's skin is proportional to the resistance (R) of the skin (ie, according to Ohm's Law wherein V=i R.sub.skin), the voltage requirements of the power supply are not constant during electrotransport delivery. For example, when electrotransport administration is begun, the patients initial skin resistance is relatively high, requiring the power supply to produce relatively high voltage to deliver a predetermined level of electrotransport current. However, after several minutes (ie, after about 1 to 30 minutes of current being applied through the skin) the skin resistance drops, such that the voltage requirement needed to deliver a particular level of electric current becomes significantly less than the voltage required at the start of electrotransport delivery. See for example Haak et al U.S. Pat. No. 5,374,242 which discloses the variable skin resistance and the use of 2 or more batteries connected either in parallel or in series to accommodate the changing skin resistance.
Although conventional voltage boosting circuits can supply the output voltage necessary to accommodate the high initial skin resistance, they reduce the efficiency of the apparatus and require more battery output voltage during periods when the skin resistance is lower than the initial state, resulting in lower efficiency and increased battery size and costs.
Jacobsen et al U.S. Pat. No. 4,141,359, incorporated herein by reference, discloses a DC-DC converter having a transformer to inductively couple periodic variations of current in a primary coil to pulses of current in a secondary coil at a fixed voltage multiple of the primary power supply. These pulses of secondary coil current are conducted through the skin by therapeutic electrodes. The average, or DC value of the secondary current is controlled by an error voltage and feed back circuit such that the average value of the secondary current is held constant.
One disadvantage of the Jacobsen circuit is that the peak value of the fixed and multiplied voltage appears directly across the electrodes. The peak voltage is unnecessary for conditions where the skin resistance is low, and results in unnecessarily high current pulses of therapeutic current and possible adverse effects on the skin.